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The document is a physician referral form for the Thames Valley Children's Centre, located in London, Ontario. It provides essential client information and outlines various services available for children with special needs, including clinics for specific conditions and therapies such as physiotherapy, occupational therapy, and speech/language therapy. The form requires details from both the client and the referring physician to facilitate access to these specialized services.

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Versions	Form popularity	Fillable & printable
2018	4.8 Satisfied (85 Votes)

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